<!DOCTYPE html>
<html lang="zh" xmlns:th="http://www.thymeleaf.org" >
<head>
    <th:block th:include="include :: header('新增危险因素')" />
</head>
<body class="white-bg">
    <div class="wrapper wrapper-content animated fadeInRight ibox-content">
        <form class="form-horizontal m" id="form-CaseDangerExposure-add">
            <div class="form-group">    
                <label class="col-sm-3 control-label">病例ID：</label>
                <div class="col-sm-8">
                    <inputname="caseid"  class="form-control" type="text"   readonly="readonly">
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">其他工作：</label>
                <div class="col-sm-8">
                    <input name="otherJob"  class="form-control" type="text"  required="required">
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">孕周：</label>
                <div class="col-sm-8">
                    <input name="gestationalWeek"  class="form-control" type="text"  required="required">
                </div>
            </div>
            <div class="form-group">
                <label class="col-sm-3 control-label">既往疾病史：</label>
                <div class="col-sm-8">
                    <textarea name="diseaseHistory" class="form-control"></textarea>
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">其他疾病：</label>
                <div class="col-sm-8">
                    <input name="otherDis"  class="form-control" type="text"  required="required">
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">统计单选1：</label>
                <div class="col-sm-8">
                    <input name="radiobutton1"  class="form-control" type="text"  required="required">
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">地址：</label>
                <div class="col-sm-8">
                    <input name="address"  class="form-control" type="text"  required="required">
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">统计单选2：</label>
                <div class="col-sm-8">
                    <input name="radiobutton2"  class="form-control" type="text"  required="required">
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">统计单选3：</label>
                <div class="col-sm-8">
                    <input name="radiobutton3"  class="form-control" type="text"  required="required">
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">统计单选4：</label>
                <div class="col-sm-8">
                    <input name="radiobutton4"  class="form-control" type="text"  required="required">
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">统计单选5：</label>
                <div class="col-sm-8">
                    <input name="radiobutton5"  class="form-control" type="text"  required="required">
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">统计单选6：</label>
                <div class="col-sm-8">
                    <input name="radiobutton6"  class="form-control" type="text"  required="required">
                </div>
            </div>
        </form>
    </div>
    <th:block th:include="include :: footer" />
    <script th:inline="javascript">
        var prefix = ctx + "system/CaseDangerExposure"
        $("#form-CaseDangerExposure-add").validate({
            focusCleanup: true
        });

        function submitHandler() {
            if ($.validate.form()) {
                $.operate.save(prefix + "/add", $('#form-CaseDangerExposure-add').serialize());
            }
        }
    </script>
</body>
</html>